Background: There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography(IOC) in the detection and treatment of common bile duct injury(BDI...Background: There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography(IOC) in the detection and treatment of common bile duct injury(BDI) or retained stones during cholecystectomy. The best evidence so far regarding IOC and reduced morbidity related to BDI and retained common bile duct stones was derived from large populationbased cohort studies. Population-based studies also have the advantage of reflecting the outcome of the procedure as it is practiced in the community at large. However, the outcomes of these population-based studies are conflicting. Data sources: A systematic literature search was conducted in 2020 to search for articles that contained the terms “bile duct injury”, “critical view of safety”, “bile duct imaging” or “retained stones” in combination with IOC. All identifed references were screened to select population-based studies and observational studies from large centers where socioeconomic or geographical selections were assumed not to cause selection bias. Results: The search revealed 273 references. A total of 30 articles fulflled the criteria for a large observational study with minimal risk for selection bias. The majority suggested that IOC reduces morbidity associated with BDI and retained common bile duct stones. In the short term, IOC increases the cost of surgery. However, this is offset by reduced costs in the long run since BDI or retained stones detected during surgery are managed immediately. Conclusions: IOC reduces morbidity associated with BDI and retained common bile duct stones. The reports reviewed are derived from large, unselected populations, thereby providing a high external validity. However, more studies on routine and selective IOC with well-defned outcome measures and sufficient statistical power are needed.展开更多
There is a great need for a more stringent and uniform use of antibiotic prophylaxis in general surgery.The decision to prescribe antibiotics is often made based on local routines or poorly defined reasons for prophyl...There is a great need for a more stringent and uniform use of antibiotic prophylaxis in general surgery.The decision to prescribe antibiotics is often made based on local routines or poorly defined reasons for prophylaxis,with no evidence base or concern about increasing microbial drug resistance.展开更多
文摘Background: There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography(IOC) in the detection and treatment of common bile duct injury(BDI) or retained stones during cholecystectomy. The best evidence so far regarding IOC and reduced morbidity related to BDI and retained common bile duct stones was derived from large populationbased cohort studies. Population-based studies also have the advantage of reflecting the outcome of the procedure as it is practiced in the community at large. However, the outcomes of these population-based studies are conflicting. Data sources: A systematic literature search was conducted in 2020 to search for articles that contained the terms “bile duct injury”, “critical view of safety”, “bile duct imaging” or “retained stones” in combination with IOC. All identifed references were screened to select population-based studies and observational studies from large centers where socioeconomic or geographical selections were assumed not to cause selection bias. Results: The search revealed 273 references. A total of 30 articles fulflled the criteria for a large observational study with minimal risk for selection bias. The majority suggested that IOC reduces morbidity associated with BDI and retained common bile duct stones. In the short term, IOC increases the cost of surgery. However, this is offset by reduced costs in the long run since BDI or retained stones detected during surgery are managed immediately. Conclusions: IOC reduces morbidity associated with BDI and retained common bile duct stones. The reports reviewed are derived from large, unselected populations, thereby providing a high external validity. However, more studies on routine and selective IOC with well-defned outcome measures and sufficient statistical power are needed.
基金This work was supported by the Rut and Rikard Julin Research Foundation.
文摘There is a great need for a more stringent and uniform use of antibiotic prophylaxis in general surgery.The decision to prescribe antibiotics is often made based on local routines or poorly defined reasons for prophylaxis,with no evidence base or concern about increasing microbial drug resistance.
